Induction characteristics of thiopentone/suxamethonium, propofol/alfentanil or halothane alone in children aged 1-3 years

The aim of this study was to compare the effect of three different inductio n techniques, with or without neuromuscular block, on tracheal intubation, haemodynamic responses and cardiac rhythm. Ninety children, aged 1-3 years, undergoing day-case adenoidectomy were randomly allocated to three groups: group TS received thiopentone 5 mg kg(-1) and suxamethonium 1.5 mg kg(-1), group H 5 Vol.% halothane and group PA alfentanil 10 mu g kg(-1) and propo fol 3 mg kg(-1) for induction of anaesthesia. No anticholinergics were used . Holter-monitoring of the heart rate and rhythm was started at least 15 mi n before induction of anaesthesia and continued until 3 min after intubatio n. Tracheal intubation was performed by an anaesthetist blinded to the indu ction method and judged as excellent, moderate or poor according to ease of laryngoscopy, position of vocal cords and incidence of coughing after intu bation. Tracheal intubation was successful at the first attempt in all chil dren in groups TS and H and but only in 80% in group PA (P=0.001). Intubati ng conditions were excellent in 22 (73%), 22 (73%) and one (3%) of the pati ents in groups TS, H and PA, respectively (P=0.001). Cardiac dysrhythmias ( supraventricular extrasystole or junctional rhythm) occurred in two (7%) pa tients in groups PA and H each (NS). Bradycardia occurred in 0 (0%), four ( 14%) and six (21%) children in groups TS, H and PA, respectively (P=0.007 P A vs.TS, P=0.03 H vs. TS). In conclusion, induction of anaesthesia with pro pofol 3 mg kg(-1) and alfentanil 10 mu g kg(-1) without neuromuscular block did not provide acceptable intubating conditions in children 1-3 years, al though it preserved arterial pressure better than thiopentone/suxamethonium or halothane. Cardiac dysrhythmias were few regardless of the induction me thod.